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Neuro Shelf Flashcards

1
Q

26 yo female patient presents with altered mentation, focal cranial nerve deficits, hemiparesis, seizures, aphasia, ataxia, and fever

A

HSV-1 encephalitis

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2
Q

What are some symptoms of herpes encephalitis?

A
  • altered mentation
  • focal cranial nerve
  • hemiparesis
  • dysphasia
  • aphasia
  • ataxia
  • focal seizures
  • FEVER
  • seizures
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3
Q

What lobe does herpes encephalitis attack?

A

temporal

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4
Q

treatment of choice for herpes encephalitis?

A

IV acyclovir

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5
Q

CSF characteristics of herpes encephalitis

A
  • lymphocytosis
  • increased erythrocytes
  • elevated protein levels
  • low CSF glucose levels
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6
Q

What does imaging show in herpes encephalitis?

A

temporal lobe lesions- use MRI

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7
Q

what is the gold standard for diagnosis of herpes encephalitis?

A

PCR analysis of HSV DNA in the CSF

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8
Q

What is the hallmark sign of myasthenia gravis?

A

resolution of muscular weakness with rest

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9
Q

What is acute steroid myopathy and how soon does it occur?

A
  • occurs w/in 1 week of drug initiation and
  • diffuse muscle weakness and rhabdpmyolysis
  • pts present w proximal mm weakness, difficulty rising from chair, combing hair, climbing stairs
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10
Q

Symptoms ofpolymyalgia rheumatica?

A
  • seen in 50% of patients with temporal arteritis
  • present with aching and morning stiffness, pain in shoulders, hip girdle, and neck
  • increased ESR
  • sx improve w steroids
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11
Q

What are some typical causes of vestibulopathy?

A
  • Meniere’s disease
  • perilymphatic fistulas
  • benign positional vertigo
  • labrynthitis
  • acoustic neuromas
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12
Q

what is anisocoria?

A

unequal size of the eys oupils

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13
Q

what nerve lesion results in impaired corneal sensation?

A

Trigeminal Nerve- V1 specifically

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14
Q

What might you find on CT scans of pts w alzheimers dementia?

A
  • cortical and subcortical arophy, specifically in the parietal and temporal lobes (hippocampi)
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15
Q

What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?

A
  1. Acute onset
  2. Occipital headache
  3. repeated vomiting
  4. Gait ataxia
    Large:
    - 6th nerve palsy
    - conjugate deviation
    - blepharospasm
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16
Q

What are the clinical signs of cerebellar hemorrhage? What else would you see in a large hemorrhage?

A
  1. Acute onset
  2. Occipital headache
  3. repeated vomiting
  4. Gait ataxia
    Large:
    - 6th nerve palsy
    - conjugate deviation
    - blepharospasm
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17
Q

What medication can slow the long-term progression of relapsing-remitting MS? what about progressive MS?

A

RR: IFN-beta
Progressive: immunosuppressive agents (cyclosporine, methrotrexate, mitoxantrone)

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18
Q

Areflexic weakness in the upper extremities + anesthesia (loss of pain and temp) with preserved position and vibration in a cape like distribution

A

syringomyelia

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19
Q

what is the pathology behind syringomyelia?

A

cavitary expansion of the spinal cord destroying gray and white matter adjacent to the central canal

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20
Q

What does neuroimaging show in Arnold-Chiari malformation?

A

caudal displacement of the fourth ventrical due to displacement of the cerebellar tonsils through the foramen magnum

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21
Q

what are some risk factors for pseudotumor cerebri? aka idiopathic intracranial HTN

A
  1. Meds: corticosteroids, OCPs
  2. Trauma
  3. Obesity
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22
Q

What are some initial symptoms of pseudotumor cerebri? (aka IIH)

A
  • pulsatile HA that usually awakens pt from sleep and is assoc with pulsatile tinnitus (whooshing sound in ears)
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23
Q

MRI reveals an empty sella tursica and slit like ventricles

A

pseudotumor cerebri

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24
Q

What is Dejerine Roussy syndrome?

A
  • stroke involving the VPL nucleus of the thalamus which transmits sensory information from the contralateral side o the body
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25
Q

What is Dejerine Roussy syndrome?

A
  • stroke involving the VPL nucleus of the thalamus
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26
Q

what is the clinical presentation of a VPL thalamic stroke?

A
  • hemianesthesia accompanied by transient hemiparesis, athetosis or ballistic movements
  • thalamic pain phenomenon: dysesthesia of the area affected by the sensory loss
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27
Q

what is the most significant complication of IIH?

A

blindness!

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28
Q

What are some characteristics of an MCA stroke?

A
  • contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
  • dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia
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29
Q

What are some characteristics of an MCA stroke?

A
  • contralateral motor and/or sensory deficits that are more pronounced in the upper limb than the lower
  • dominant lobe= aphasia, nondominant lobe= neglect and/or anosognosia
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30
Q

What is anosognosia?

A

deficit of self-awareness, don’t acknowledge that theres a neurologic problem

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31
Q

Chatacteristics of a PCA stroke?

A

homonymous hemianopia

  • alexia (loses ability to read) without agraphia
  • Visial hallucinations (calcarine cortex)
  • sensory symptoms
  • third nerve palsy w pareses of vertical eye mvmt
  • motor deficits (cerebral peduncle, midbrain)
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32
Q

what is Amaurosis fugax??

A

Temporary monocular blindness

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33
Q

What are some syndromes of lacunar infarcts?

A
  • pure motor hemiparesis
  • pure sensory stroke
  • dysarthria- clumsry hand
  • ataxic hemiparesis
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34
Q

What is glatiramer acetate?

A
  • tx for MS
  • decreases disease frequency and severity of MS exacerbations
  • induces suppressor T cells that downregulate the T cell mediated immune response to myelin antigens that underlies MS
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35
Q

What is the standard concoction for pts with confusion?

A
  1. Thiamine for Wernicke’s
  2. Dextrose for hypoglycemia
  3. Supplemental Oxygen for hypoxia
  4. Naloxone for opiate overdose
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36
Q

What injury to the brain occurs in prolonged seizures?

A
  • cortical laminar necrosis: can lead to persistent neurologic deficits and recurrent seizures
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37
Q

What injury to the brain occurs in prolonged seizures?

A
  • cortical laminar necrosis: can lead to persistent neurologic deficits and recurrent seizures
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38
Q

What are some characteristics of brain metastasis?

A
  • duration of symptoms of less than 2 months

- occur in the gray-white junction or watershed zones

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39
Q

What are some characteristics of brain metastasis?

A
  • duration of symptoms of less than 2 months

- occur in the gray-white junction or watershed zones

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40
Q

what is the pathogenesis of CN III neuropathy in diabetic mononeuropathy?

A
  • ischemic! but only of somatic fibers bc somatic and parasympathetic fibers have separate blood supplies
  • this leads to down and out gaze
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41
Q

young patient + myoclonus + dementia

A

CJD

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42
Q

young patient + myoclonus + dementia

A

CJD

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43
Q

what is anisocoria?

A

unequal pupils

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44
Q

Visual field defects usually means a problem with what?

A

the retina or optic nerve (pre-chiasm)

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45
Q

What is RAPD?

A

marcus gunn pupil- pupil doesn’t constrict to direct light but constricts to direct accommodation

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46
Q

where do CN II fibers synapse?

A

pretectal midbrain nuclei aka the Edinger-Westphal nuclei in the rostral portion of the third nerve nucleus

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47
Q

What are the characteristics of a third nerve palsy?

A
  • ptosis
  • dilated pupil
  • ophthalmoplegia
    eye is down and out
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48
Q

What are the characteristics of a third nerve palsy?

A
  • ptosis
  • dilated pupil
  • ophthalmoplegia
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49
Q

What is Adie’s pupil? How do you confirm it?

A
  • a tonic pupil that results from interruption of the PSNS supply from the ciliary ganglion
    Sx =
    1. Anisocoria
    2. Photophobia
    3. Blurred near vision
    -Confirmed via 0.1% pilocarpine which will produce more contraction in the affected pupil than in the normal pupil
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50
Q

What is Adie’s pupil? How do you confirm it?

A
  • a tonic pupil that results from interruption of the PSNS supply from the ciliary ganglion
    Sx =
    1. Anisocoria
    2. Photophobia
    3. Blurred near vision
    -Confirmed via 0.1% pilocarpine which will produce more contraction in the affected pupil than in the normal pupil
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51
Q

Sudden painless vision loss in HTN and DBM pt >50

A

Anterior ischemic optic neurpathy (AION)

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52
Q

What is the etiology of AION?

A

vascular: carotid occlusion, embolic TIAs
Inflammatory: temporal arteritis

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53
Q

what do you see on fundoscopic exam of AION?

A

unilateral segmental disc edema

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54
Q

what is Foster Kennedy syndrome?

A

Ipsilateral optic disc atrophy due to compression by a space occupying lesion in the frontal lobe and papilledema in the contralateral optic disc due to increased ICP

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55
Q

What is the treatment for IIH?

A

Acetazolamide
Nerve decompression
Shunt

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56
Q

What does fundoscopic exam show in drusens?

A

glistening hyaline bodies + VP

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57
Q

What does fundoscopic exam show in drusens?

A

glistening hyaline bodies + VP

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58
Q

What is Uhthoff’s phenomenon?

A

worsening visual function during exercise, hot baths, etc.

seen in optic neuritis- usually from MS

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59
Q

Central scotoma is classic for what?

A

Optic neuritis

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60
Q

what is phoria?

A

misalignment of the eyes when binocular vision is absent

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61
Q

what is tropia?

A

misalignment of the eyes when both eyes are opened and binocular vision is possible

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62
Q

what is strabismus?

A

misalignment of the eyes

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63
Q

lesion to CN IV causes what?

A

oblique diplopia- worse on downgaze when affected eye is adducted (pt complains of diplopia when reading or going down stairs)

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64
Q

What does the MLF connect specifically? what happens when there is a lesion to the right MLF?

A

the abducens nucleus with the contralateral third nerve

R MLF = inability to adduct the right eye in left lateral gaze plus nystagmus of the abducting left eye

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65
Q

What is one and a half syndrome?

A

Lesion to the PPRF, sixth nerve palsy, and adjacent ipsilateral MLF
- ipsilateral gaze palsy and INO on the contralateral side

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66
Q

Abnormal vertical gaze movements can be found in what syndromes?

A

Dorsal midbrain

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67
Q

What is parinaud syndrome?

A
  1. Upgaze disturbance,
  2. Convergence-retraction nystagmus on attempted upgaze
  3. Light near dissociation of the pupils
    (usually produced by pineal tumor compressing the dorsal midbrain)
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68
Q

what are exotropia and esotropia?

A 
exotropia = eyes turned outward (third nerve palsy)
esotropia = eyes turned inward (abducens palsy)
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69
Q

What is oculomotor apraxia?

A

inability to produce saccades

70
Q

What is oculomotor apraxia?

A

inability to produce saccades

71
Q

What are some characteristics of NMJ disorders?

A
  • decree of weakness fluctuates from hour to hour

- no sensory loss

72
Q

What are some characteristics of NMJ disorders?

A
  • decree of weakness fluctuates from hour to hour

- no sensory loss

73
Q

Name the nerve root of the reflex:

Biceps

A

C5

74
Q

Name the nerve root of the reflex:

Finger Flexor

A

C8/T1

75
Q

Name the nerve root of the reflex:

Hip adductor

A

L3

76
Q

Name the nerve root of the reflex:

Triceps

A

C7

77
Q

Name the nerve root of the reflex:

Patellar

A

L4

78
Q

Name the nerve root of the reflex:

Brachioradialis

A

C6

79
Q

Ankle jerk

A

S1

80
Q

in UMN lesions, what happens to upper extremity muscles versus lower?

A

Upper: extensors and abductors become weaker than flexors and adductors
Lower: mm that shorten the leg (flexion) are weaker than the extensors

81
Q

in UMN lesions, what happens to upper extremity muscles versus lower?

A

Upper: extensors and abductors become weaker than flexors and adductors
Lower: mm that shorten the leg (flexion) are weaker than the extensors

82
Q

lesions in the internal capsule may lead to weakness where?

A

in the contralateral face, arm, and leg

83
Q

lesions in the base of the pons may lead to weakness where?

A

ipsilateral face, contralateral arm and leg

84
Q

Where does the spinalthalamic pathway decussate?

A

at the level of the spinal cord in the dorsal horn

85
Q

Where does the dorsal column medial lemniscus pathway decussate?

A

lower medulla in the nuclei gracilis and cuneatus, cross to form the medial lemniscus

86
Q

What is the somatotopic arrangement of the dorsal column pathway?

A

legs medially in the fasciculus gracilis

arms laterally in the fasciculus cuneatus

87
Q

What is the somatotopic arrangement of the dorsal column pathway?

A

legs medially in the fasciculus gracilis

arms laterally in the fasciculus cuneatus

88
Q

where does the spinothalamic tract terminate?

A

VPL of the thalamus

89
Q

where does the trigeminal tract terminate?

A

VPM of the thalamus

90
Q

What is the etiology of menieres disease?

A

an intermittent increase in endolymphtic volume

91
Q

What is the etiology of menieres disease?

A

an intermittent increase in endolymphtic volume

92
Q

What is dysdiadochokinesia?

A

abnormality of ther ate and rhythm of a movement demonstrated by asking the pt to perform a rapid alternating movement

93
Q

What is dysarthria?

A

slow scanning and monotonous speech

94
Q

Pt is 4yo child with recent URI shows signs of gait ataxia and dysarthria?

A

Postinfectious cerebellitis

(affects kids aged 2-7) lasts a few weeks, diagnosis of exclusion

95
Q

pancerebellar syndrome that evolves to its maximum in weeks and then stabilizes?

A

Paraneoplastic cerebellar degeneration: assoc with underlying gynecologic, SCLC
- MRI normal CSF may show elevated protein or lymphocytic pleo but mostly normal

96
Q

what autoantibodies are assoc with Paraneoplastic cerebellar degeneration?

A

anti-yo and anti-hu

97
Q

loss of reflexes, spasticity and extensor plantar responses and impaired vibration/position sense in a child

A

friedreich ataxia

98
Q

loss of reflexes, spasticity and extensor plantar responses and impaired vibration/position sense in a child

A

friedreich ataxia

99
Q

Insidious onset of progressive impairment of gait and dysarthria in early adult life with associated neurologic abnormalities + family history

A

Autosomal Dominant Spinocerebellar Degenerations (many cause a trinucleotide expansion)

100
Q

what is detected in the serum of patients w Miller Fisher Syndrome?

A

IgG anti-GQ1b antibodies

101
Q

what is detected in the serum of patients w Miller Fisher Syndrome?

A

IgG anti-GQ1b antibodies

102
Q

What is astasia-abasia?

A

acrobatic psychogenic gait

103
Q

What is astasia-abasia?

A

acrobatic psychogenic gait

104
Q

What type of urinary issues do parkinsons pts have?

A

voiding dysfunction- sphincter bradykinesia as well as BPH assoc

105
Q

What type of urinary issues do parkinsons pts have?

A

voiding dysfunction- sphincter bradykinesia as well as BPH assoc

106
Q

what is the treatment of trigeminal neuralgia?

A

Carbamazepine (then other AEDs)

Refractory cases= percutaneous radiofrequency ablation and microvascular decompresison

107
Q

what is the pathophys of trigeminal neuralgia?

A

compression of the trigeminal nerve root at the cerebellopontine angle, most often by an aberrant vascular loops

108
Q

what is PHN? treatment?

A
  • neuropathic pain that accompanies and follows an acute attack of shingles
    tx: acyclovir for shingles, then TCAs and gabapentin for PHN
109
Q

what is one feature of almost all aphasias?

A

anomia! inability to name things

110
Q

what are neologisms?

A

nonexistent words

111
Q

how are wernickes and brocas different?

A
  • ppl with wernices seem unaware of their deficit initially and can become quite angry with others having difficulty understanding them, unlike Brocas
112
Q

where is wernickes area located?

A

posterior part of the superior temporal gyrus in the dominant hemisphere

113
Q

what is alexia without agraphia aka pure alexia? what lesion causes it?

A

inability to read despite a preserved ability to write- lesion in the dominant occipital lobe (also can involve the splenium of the corpus callosum)

114
Q

what kind of apraxias do lesions to the parietal lobe cause?

A

pts cannot recognize the task being done correctly

115
Q

what kind of apraxias do lesions to the parietal lobe cause?

A

pts cannot recognize the task being done correcty

116
Q

what is prosopagnosia and where is the lesion?

A
  • inability to recognize faces

- R hemispheric or bilateral lesions in the visual association area

117
Q

What is Gerstmann’s syndrome?

A
  • lesion in the inferior parietal lobule of the dominant hemisphere (angular gyrus)
    1. Agraphia (inability to write)
    2. Acalculi
    3. Right-Left confusion
    4. Finger agnosia
118
Q

What is anosognosia?

A

pts with right hemisphere lesions have a tendency to be unaway of their deficits

119
Q

what gene (and chromosome) is assoc with both early and late onset AD?

A

ApoE4 on chromosome 19

120
Q

Early onset AD is assoc with what mutation on what chromosome?

A

APP on chromosome 21
PS1 on chromosome 14
PS2 on chromosome 1

121
Q

what does sundowning mean in terms of AD?

A

psychiatric manifestations are worse during the evening and night

122
Q

What is a rare side effect of donepezil and rivastigmine?

A

hepatic toxicity

common: diarrhea and abdominal cramps

123
Q

What is a rare side effect of donepezil and rivastigmine?

A

hepatic toxicity

common: diarrhea and abdominal cramps

124
Q

what is a side effect of clopidogrel?

A

Can produce TTP

125
Q

What drugs are used to treat lewy body dementia?

A

Low doses of atypical neuroleptics:

- Risperidone and clozapine

126
Q

what is the genetic dysfxn in huntingtons dx?

A

> 40 CAG repeats on chromosome 4

127
Q

what is the genetic dysfxn in huntingtons dx?

A

> 40 CAG repeats on chromosome 4

128
Q

what are the characteristic pathologic changes seen in Picks disease?

A

pick bodies- argyrophilic round intraneuronal inclusions

129
Q

presence of protein 14-3-3 in the CSF?

A

CJD!

130
Q

What is the most common cause of nontraumatic SAH?

A

saccular aneurysms!

131
Q

Tx of choice for agitation in the eldery?

A

Haloperidol

132
Q

What is the treatment for Shy-Drager syndrome aka multiple system atrophy?

A
  1. Fludrocortisone
  2. Salt supplementation
  3. Alpha adrenergic agonists
133
Q

What are the characteristics of multiple system atrophy?

A
  1. Parkinsonism
  2. Autonomic dysfunction
  3. Widespread neurological signs
134
Q

What is familial dysautonomia?

A

autosomal recessive disease

  • children of ashkenazi jewish ancestry
  • gross dysfunction of the ANS with severe orthostatic hypotension
135
Q

What is horner’s syndrome?

A
  • regional dysautonomia
    1. Anhydrosis
    2. Miosis
    3. Ptosis
136
Q

what is torticollis?

A

a focal dystonia of the SCM muscle

137
Q

what medications can cause torticollis?

A
  1. typical antipsychotics
  2. Metoclopramide
  3. Prochlorperazine
138
Q

what is akathisia?

A

sensation of restlessness that causes pt to move frequently

139
Q

what is the most common cause of myasthenia crisis?

A

intercurrent infection

140
Q

what reflex can be seen in a pt with brain death?

A

deep tendon reflexes

141
Q

why do people suffering from heat stroke have blood in their urine?

A

rhabdomyolysis- the increased body temperature can cause it and organ system damage

142
Q

Where are plaques of MS most commonly located? (4)

A
  1. Periventricular regions
  2. Corpus callosum
  3. Deep white matter
  4. Basal ganglia
143
Q

What causes a Subdural hematoma?

A

tearing of the bridging veins from minor trauma (crescent shaped)

144
Q

what causes a biconvex hematoma on ct?

A

epidural hematoma- tearing of the middle meningeal artery

145
Q

what causes a subarachnoid hemorrhage?

A

rupture of an aneurysm

146
Q

where do most of the emboli come from in amaurosis fugax?

A

(painless vision loss from emboli) from the carotid bifurcation

147
Q

what is a good distinguishing factor between alzheimers dementia and pseudodementia?

A

ppl w pseudodementia are seem generally concerned about their memory loss, alzheimers seem unconcerned

148
Q

tx of choice for NPH?

A

surgical bypass shunting

149
Q

what are two medical tx of essential tremor?

A
  1. Beta blockers
  2. Primidone- anticonvulsant that can cause porphyria, which manifests as abdominal pain, neurologic and psychiatric abnormalities
150
Q

what is trihexyphenidyl?

A

anticholinergic- used for parkinsons disease and drug induced extrapyramidal symptoms

  • benztropine is another agent in this class
  • causes anticholinergic side effects and closed angle glaucoma
  • typically used in younger patients where tremor is predominant
151
Q

Brown-seguard syndrome is assoc w damage to the lateral spinothalamic tracts- where do the symptoms show up?

A

contalateral loss of pain and temperature sensation beginning to levels below the level of the lesion

152
Q

what is the underlying genetic mutation in NF2?
also-
1. Wishart version (severe variant)
2. Gardner (milder varint)

A

Autosomal dominant cause by a mutation in the tumor suppressor gene on chromosome 22-

  1. Wishart = frameshift or nonsense
  2. Gardner = missense or splice site
153
Q

Atrophy of the lenticular nucleus is most common in what?

A

Wilson’s disease!

154
Q

What is the imaging modality of choice for diagnosis of CST?

A

MRI with MRV

155
Q

What is metoclopramide? what is it used for? side effects?

A
  • DA receptor antagonist
  • used for nausea, vomiting and gastroparesis
  • se = agitation, loose stools, EPSEs and NMS
156
Q

what is the tx for a dystonic reaction?

A
  • discontinuation of the medication

- administration of benztropine or diphenhydramine

157
Q

sharp, triphasic synchronous discharges on EEG

A

CJD

158
Q

EBV DNA in the CSF + ring enhancing mass that is solitary and periventricular

A

Primary CNS lymphoma

159
Q

multiple ring enhancing spherical lesions in the BG

A

toxoplasmosis

160
Q

what is titubation?

A

forward and backward motion of the trunk

161
Q

pt has ipsilateral ataxia and falls towards one side, also exhibits titubation, nystagmus, intention tremor

A

cerebellar tumor

162
Q

loss of proprioception + pt walks w legs wide apart, feet are lifted higher than usual and make a slapping sound when come in contact with the floor, romberg +

A

tabes dorsalis

163
Q

restless leg syndrome is more common in what population?

A

CKD and or iron deficiency anemia

164
Q

MOA of restless leg syndrome?

A

abnormalities in dopaminergic transmission in the CNS- use DA agonists (pramipexole and ropinerole) or levodopa)

165
Q

What are the most common causes of foot drop?

A
  1. Neuropathy
  2. L5 radiculopathy
  3. Traumatic damage to the common peroneal nerve
166
Q

CSF shows elevated protein and normal cell count (albumino-cytologic dissociation)

A

GBS

167
Q

What is wallenberg syndrome?

A

lesion of the lateral medulla:

  • ipsilateral Horner syndrome
  • loss of pain and temperature sensation of the face
  • weakness of the palate, pharynx, and vocal cords
  • cerebellar ataxia
  • loss of pain and temp on contralateral side of the body
168
Q

pathophys of NPH?

A

transient increase in ICP that causes ventricular enlargement

169
Q

Symptoms of Cauda equina syndrome?

A
  • a serious disorder of spinal nerve roots
  • low back pain
  • bowel and bladder dysfunction
  • saddle anesthesia
  • sciatica
  • lower extremity sensory and motor loss
170
Q

thenar eminence atrophy?

A

median nerve involvement

171
Q

what is the major cause of morbidity and mortality in subarachnoid hemorrhage? how do you prevent it?

A

vasospasm with symptomatic ischemia and infarction

- prevented with Ca channel blockers

172
Q

what is an expected electrolyte abnormality iwth subarachnoid hemorrhage?

A

hyponatremia = cerebral salt wasting syndrome

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